Healthcare providers who already use electronic health records urged a federal health IT advisory panel last week to add more goals for improving patient care coordination into the meaningful use financial incentive plan.
These include sharing information about the medications that they prescribe their patients and merging them into their electronic records as patients obtain treatment from multiple physicians.
The resulting medication reconciliation would improve coordination of care and patient safety by avoiding duplication and potential adverse drug effects, according to one of the physicians testifying at the Aug. 5 meeting of the Health IT Policy Committee's meaningful use work group.
"Medication reconciliation is an absolute requirement to help ensure medication safety during transitions in care," said Jeffrey Schnipper, MD, who practices at Brigham and Women's Hospital in Boston.
"I have seen first-hand how the inadequate transfer of information across healthcare settings leads to avoidable injury and unnecessary healthcare utilization, including needless readmissions to the hospital," he told the panel.
It was one of several proposals for incorporating care coordination into meaningful use and certification of electronic health records that emerged from the meeting as the group begins to consider requirements for the next stage of meaningful use.
The first stage of meaningful use only requires providers to be able to electronically compare two or more medication lists.
EHRs should also be able to import medication data from other sources, display and compare different medication lists, order medications and document that information, Schnipper said. Systems also need to be able to pull data from inpatient and outpatient EHRs and from community pharmacy prescription data.
"Comparisons should be displayed in such a way that they make differences in these various data sources obvious," he said.
Current EHRs are unable to easily display and compare medication lists, said Paul Tang, MD, the panel chairman and chief medical information officer at Palo Alto Medical Foundation.
"Even if you have systems and you were magically connected to everybody, you still can't see what you need to see very quickly," he said. "Those are things that could be improved potentially with the health IT incentives and certification process."
Christine Sinsky, MD, a physician in a multi-specialty practice in Dubuque, Iowa, said there needs to be commonly accepted methods for systems to display patient information, which currently can be scattered or hidden in other data. For instance, problem lists arranged in chronological order would improve a physician's ability to grasp a patient's medical history.
"It's easy to overlook a recent procedure buried in a multi-page list of alphabetized entries," she said.
Similarly, EHRs may list medications by class, organ system, or alphabetical order. The medication list of a patient with multiple chronic illnesses often exceeds 20 entries and spans several pages of text.
"I have found it is distressingly easy, for example, to overlook one of a patient's four cardiovascular medications scattered throughout such a list," Sinsky said.
